ADDISON’S DISEASE

DEFINITION & CLASSIFICATION

 ADDISON’S DISEASE [primary adrenocortical insufficiency] caused by destruction/dysfunction
of adrenal cortex

AETIOLOGY

 WATERHOUSE- FRIDERICHSEN SYNDROME→ adrenal haemorrhage occurs secondary to

meningococcal septicaemia

CLINICAL FEATURES
 Often diagnosed late due to its non-specific presentation

 Think of Addison’s in unexplained abdominal pain/vomiting

Addisonian crisis
o Mostly commonly seen in secondary adrenal insufficiency due to sudden withdrawal of
exogenous steroids

o occur in primary adrenal insufficiency, typically following an acute decompensation where

an additional stress (e.g. infection) results in an exacerbation of a pre-existing deficiency

o Bilateral adrenal gland haemorrhage

o presents with symptoms of profound glucocorticoid deficiency→ dehydration,

hypotension and confusion

o Blood tests→ hyponatraemia and hypoglycaemia

Chronic disease
o Chronic insidious onset

INVESTIGATIONS & DIAGNOSIS

 BLOOD TESTS

 Serum cortisol

o < 100 nanomol/L: admit to hospital

 o 100–500 nanomol/L: refer for synacthen test, consider admission if symptoms are
severe

o > 500 nanomol/L: Addison’s is unlikely

 SYNACTHEN TEST

 Administration of 250mg of tetracosactide [analogue of ACTH]

 Cortisol measured 0, 30 and 60 minutes following administration

 Normal response sees rise in cortisol >500–550 nanomol/L

MANGEMENT

 GLUCORTICOID REPLACEMENT

 Hydrocortisone 15-30 mg/day given in divided doses

 MINERALOCORTICOID REPLACEMENT

 Fludrocortisone 50-300 mcg

 ADDISONIAN CRISIS

 Medical emergency!

 IV hydrocortisone 100mg and IV fluid rehydration

 Patient education

o Treatment lifelong

o Intercurrent illness requires adjustment of dose